Practical clinical management strategies for the allergic patient with chronic rhinosinusitis:

Morphometric assessment of important landmarks on skull intended for Vidian nerve surgery

PURPOSE

The aim of our study was to determine guide parameters for clinicians by morphometric assessment of important landmarks on cranium intended for Vidian nerve surgery.

METHODS

For the study, 23 half-skull bases, 40 skull bases and 40 skulls were obtained from the Department of Anatomy, Ege University Medicine Faculty. The vertical distances were measured using a digital caliper to the nearest 0.01 mm.

RESULTS

The anterior opening of the Vidian canal (pterygoid canal) was observed as oval shaped on 57 specimens (31.1%), funnel shaped on 58 specimens (31.7%), round shaped on 64 specimens (35%) and septated on 4 specimens (2.2%). Vidian canal was embedded into the body of sphenoid on 55 specimens (52.4%) (embedded type) and protruded to sphenoidal sinus on 50 specimens (47.6%) (protruded type). 21 specimens of 50 were partial and 29 specimens were total. There were dehiscences on 21 specimens of 50 protruded type on the base of sphenoidal sinus (20%). Anterior opening of the Vidian canal was assessed according to medial lamina of pterygoid process. It was located medially in 169 of the specimens (92.3%) and laterally in 14 specimens (7.7%).

CONCLUSION

Vidian canal and Vidian nerve are deeply located structures on skull. Vidian canal and surrounding structures are important landmarks for microsurgery and endoscopic approaches to Vidian nerve. We consider that knowledge of anatomical features of Vidian canal and preoperative imaging by CT (computed tomography) will be supportive when choosing and planning a safe surgical approach.

Can Tumor Size Be a Predictive Factor of Olfactory Dysfunction After Endoscopic Endonasal Trans-Sphenoidal Approach?

BACKGROUND AND OBJECTIVE

The aim of this study is to investigate the relationships between tumor size, nasal symptoms including olfactory function, and posoperative atrophic mucosal changes after the endoscopic endonasal transsphenoidal approach (EETSA).

METHODS

This was a retrospective review of the medical records of 112 patients who underwent the 2 nostrils/4 hands EETSA with bilateral modified nasoseptal rescue flaps between February 2009 and January 2016. Pre- and postoperative paranasal sinus computed tomography, nasal cavity endoscopic images, the Connecticut Chemosensory Clinical Research Center (CCCRC) test, Cross-Cultural Smell Identification Test (CCSIT), the Nasal Obstruction Symptoms Evaluation, and the Sino-Nasal Outcome Test-20 were conducted. Nasal mucosal changes as determined by endoscopy were divided into 4 groups: normal to normal, Group A; atrophy to atrophy, Group B; normal to atrophy, Group C; and atrophy to more atrophy, Group D. The Mimics program was used to calculate nasal cavity volume changes after surgery.

RESULTS

There were significant differences between pre- and postoperative olfactory function as reflected by the CCCRC (P < 0.001) and CCSIT (P < 0.001) scores. There was also a correlation between tumor size and olfactory function scores such as the CCCRC (P = 0.012) or CCSIT (P = 0.015). Moreover, nasal mucosal atrophic changes were related to tumor size and olfactory function tests.

CONCLUSION

The tumor size was related to olfactory function and atrophic mucosal changes. Therefore, patients with large tumors should be informed that, after the EETSA, their olfaction may be altered and that nasal symptoms related to mucosal atrophy could occur.

Practical clinical approaches to the allergic rhinitis patient

BACKGROUND

Numerous treatment strategies are available for the treatment of allergic rhinitis (AR), including environmental controls, pharmacotherapy, immunotherapy, and surgery in appropriately selected patients. A stepwise algorithmic approach based on disease severity and persistence of symptoms is often advocated to effectively manage patients with AR.

METHODS

A review is provided of current evidence and guidelines for the management of AR. Practical clinical strategies to improve patient adherence to therapy and outcome are described.

RESULTS

Algorithms to manage AR are based on the severity and persistence of disease. A tailored strategy geared toward addressing symptoms that are most troublesome to the patient is beneficial, as is the assessment of comorbid conditions such as rhinosinusitis, asthma, and laryngopharyngeal reflux. Allergen-specific immunotherapy (AIT) is an underused treatment modality and patients with persistent AR should be considered candidates for desensitization, if appropriate. Assessment of patient outcome is important and the use of validated symptom surveys can provide an objective measure of quality of life.

CONCLUSION

A large armamentarium of treatment options is available to the otolaryngologist treating the patient with AR. A step-wise and tailored approach with equal attention dedicated to patient education and assessment of patient outcome can be helpful to improve efficacy of treatment.